Underdosing of elderly associated with mortality, hospitalization

A Belgium study published July 18 by the British Journal of Clinical Pharmacology found a link between underuse of medications and hospitalization or death among patients 80 and older. "Appropriate prescribing of medications is a major challenge in the care of elderly adults because older patients tend to be more sensitive to the effects of medications than younger patients, and they often have multiple conditions requiring numerous prescriptions that could negatively interact with each other," a Wiley Science News press release stated. Researchers examined patterns of prescription drug use among 503 adults ages 80 and older who lived in communities. They followed the patients for an 18-month period. They found that more than half (58%) of patients were taking five or more chronic medications daily. "Few patients were taking medications appropriately, with underuse occurring in 67% of patients and misuse occurring in 56% of patients (with some overlap between these groups)," according to the press release. Only 17% of patients were not affected by underuse or misuse, researchers found. Specifically, the subjects were primary care patients recruited by their general practitioners. They were chosen between November 2008 and September 2009. Those with dementia or in palliative care were excluded from the study. "The general practitioner recorded all chronic medications at baseline, using the generic name," the study stated. "All chronic medications were codified entered into the Anatomical Therapeutic Chemical classification, based on the official register of medications on the Belgian market." The survival analysis of inappropriate prescribing on mortality and hospitalization showed that the mortality rate after 18 months was 8.9% and the hospitalisation rate was 31%, researchers in the study wrote. "Causes of death included cardiovascular and/or cerebrovascular related events (48.9% of deaths), cancer (20.0%),respiratory related events (13.3%), or general deterioration (6.7%)." There was a significant difference between different categories of underuse for both mortality and hospitalization, according to results of the study. Furthermore, after 18 months the survival rates for mortality for patients with no, low and high underuse were respectively 97%, 96% and 88%, according to the study, and after one year, survival rates for hospitalization were respectively 85%, 81%, and 59%. The Department of Health and Human Services states that "55% of the elderly are "non-compliant" with their prescription drug orders, meaning they don't take the medication according to the doctor's orders," according to the AgingNews.com article, "Medication Problems Elderly People Have." The article lists six reasons for potential under or overdosing, including vision problems, hearing problems when discussing medication with pharmacists, inability to swallow pills, memory loss, income and social isolation. "For elderly people, medications can be a lifeline to good health ... or a disaster waiting to happen," the article stated. "When doses are skipped or too much medication is taken, the results can be deadly." About 200,000 older adults are hospitalized annually in the U.S. due to adverse drug events, the article stated. Referencing a similar study, a June 2016 Health Day article stated patients 80 and over are 1.5 to 3 times more likely to need help with taking medication than the 65-69 age group. Elderly men were 1.5 to 2 times more likely than women to need help taking medications, according to the article. To comment, email editor@nurse.com. To learn more about maintaining balance in drug regimens for the elderly, read the CE module, "Polypharmacy in the Elderly."